Suboxone, a medication approved to treat opioid dependence and addiction in the U.S., is a mixture of the opioid antagonist drug naloxone and the partial opioid agonist buprenorphine. It is marketed as a filmstrip that is dissolved under the tongue. Suboxone may be used during opioid addiction treatment to manage withdrawal symptoms and maintain opioid abstinence long-term in recovery.
Buprenorphine is only a partial opioid agonist, which means that while it does work like other opioids by binding to opioid receptors in the brain and thus blocking pain sensations, it does not seem to produce the same kind of euphoria that full agonist opioids like heroin or OxyContin (oxycodone) do. Buprenorphine’s agonist effects also plateau at a certain point, meaning that no matter how much a person takes, the drug will not have any further effect. These characteristics of buprenorphine are said to give it a low potential for diversion and abuse.
The combination of one part naloxone to every four parts buprenorphine in Suboxone adds a layer of abuse deterrence, according to the journal Current Drug Abuse Reviews. The naloxone part of Suboxone is not well metabolized when the drug is taken as directed (sublingually) and, therefore, remains mostly dormant. If the drug is injected or combined with other opioid drugs, however, the naloxone becomes more active and can then precipitate significant withdrawal symptoms. This can be decidedly unpleasant.
Despite all of the deterrents to abuse, Suboxone is still an opioid drug, and it is still abused. The New York Times reports that Suboxone is often termed “prison heroin” and is commonly trafficked into jails and prisons where it is abused by inmates for the pleasant and mellow buzz it can create. It may also be abused as a method of self-medicating opioid withdrawal symptoms in someone who is battling addiction involving other opioids. Suboxone may seem to take the edge off and make the comedown from other opioids less intense, making it a target for abuse.
Suboxone itself is also addictive and can cause drug dependence and challenging withdrawal symptoms. Medical detox is the safest method for stopping Suboxone use, allowing the drug to safely process out of the body.
Suboxone Withdrawal Information
Since Suboxone is a partial opioid agonist drug, its effects are generally not as intense and mind-altering as those of full agonist opioids like heroin. In the same respect, the withdrawal syndrome may not be quite as significant as that of other opioids; however, it can still be difficult with both emotional and physical effects.
Buprenorphine is a long-acting opioid drug with a half-life of 24 hours to 48 hours, Pharmacy Times publishes. Naloxone has a much shorter half-life of about two to 12 hours. This means the buprenorphine component of Suboxone can remain active in the bloodstream for two to four days.
Withdrawal symptoms will start as soon as the drug’s action in the body wears off, and it processes out. Generally, there is an overall timeline Suboxone withdrawal can be expected to follow.
- Two to four days after Suboxone use is stopped, withdrawal symptoms will begin. These may include muscle aches, yawning, sweats, chills, watery eyes, runny nose, insomnia, agitation, and anxiety.
- Four to six days after the last dose of Suboxone, withdrawal symptoms generally peak and cravings can become intense. Symptoms may include goosebumps, stomach upset, nausea, vomiting, diarrhea, a racing heart rate, high blood pressure, and dilated pupils.
- A week or so after stopping Suboxone, withdrawal symptoms may begin to wane.
- Seven days to a few weeks or months after Suboxone use is stopped, withdrawal symptoms can continue. These may include sleep difficulties, trouble feeling pleasure, mental cloudiness, drug cravings, depression, and anxiety.
When someone takes Suboxone regularly, the brain can become tolerant to certain levels of it, and with chronic use, drug dependence can set in. Drug dependence means the brain will feel like it needs Suboxone to keep chemically balanced, and that’s why withdrawal symptoms and cravings happen when the drug isn’t active in the bloodstream. It can take some time for the brain to regulate itself and get used to functioning normally without Suboxone.
Medical detox can provide a safe environment that allows the drug to process out of the body while attending to the physical and emotional withdrawal symptoms through medical and supportive means.
Tapering Off Suboxone During Detox
Suboxone is a medication that can be prescribed by a doctor and dispensed through a pharmacy, which makes it different from other opioid dependence treatment medications such as methadone, which needs to be given on-site at a federally regulated clinic once or twice a day. The Substance Abuse and Mental Health Services Administration (SAMHSA) publishes that buprenorphine is typically administered in three phases when it’s used to treat opioid dependence: the induction phase, the stabilization phase, and the maintenance phase.
“Since Suboxone can cause more intense withdrawal symptoms when other opioids are present, it is often used a little later in detox or after opioids have fully cleared the system and withdrawal has started, within 12 to 24 hours after the last dose. During this initial induction phase, Suboxone use should be closely monitored. ”
Medical detox offers the highest level of care and attention during induction and into the stabilization phase. Suboxone is then tapered off slowly over a set timeframe to allow the brain to stabilize and to prevent withdrawal symptoms and cravings from being as intense. When Suboxone is the opioid drug of abuse, the same still holds true; the drug dosage will need to be slowly lowered over a safe amount of time and not stopped suddenly.
The journal Addiction provides the following rapid-taper schedule for Suboxone:
Suboxone Taper Schedule
- Day 1: Beginning dose of 16 mg
- Day 2: Drop down to 12 mg
- Day 3: Reduce dosage to 10 mg
- Day 4: Lower dosage to 8 mg
- Day 5: Reduce dosage to 4 mg
- Day 6: Drop dosage down to 2 mg
- Day 7: Dose at 2 mg again
The tapering schedule will depend on how much Suboxone a person was taking at first. For example, if the normal dosage was higher than 16 mg to start with, then the dosage may need to be adjusted accordingly. Trained medical professionals can set up a safe detox program to taper off Suboxone.
Other medications can be useful during medical detox for specific symptoms of withdrawal as long as they do not negatively interact with Suboxone. Suboxone is not to be mixed with alcohol, benzodiazepines, other opioids, or medications impacting the serotonin neurotransmitter system, the medication guide for Suboxone warns.
Suboxone withdrawal is not going to be the same for each person. The dosage amount, and the intensity and timeline of withdrawal, can be influenced factors such as how long a person has been taking the drug and in what amounts, how they took it (as directed or via injection or some other method), if other drugs were taken concurrently, and other biological, genetic, and environmental aspects.
Getting Treatment for Substance Abuse and Withdrawal
Suboxone is an opioid medication, and as such, it can be diverted, misused, and abused. It also has a high potential for drug dependence and addiction. There are many different programs where one can get help for opioid addiction. SAMHSA’s National Helpline can provide information on treatment options, locations, and referrals to local community-based treatment programs, support groups, and treatment facilities.
Treatment for Suboxone abuse and addiction can be provided in both an outpatient and an inpatient setting. Outpatient programs are great for people who need to remain at home to attend to family obligations or go to school or work during the day. Outpatient treatment offers a high level of flexibility in scheduling and is beneficial for people who do not suffer from significant drug dependence.
When dependence to Suboxone is higher or more support is desired, an inpatient treatment program is a good option. Residential, or inpatient, addiction treatment programs are more structured and provide continual and ongoing support around the clock. There are also in-between options, such as intensive outpatient programs (IOPs), which offer the structure of a residential program but the flexibility of being able to attend to other obligations in the evenings when a person returns home.
Treatment programs for Suboxone abuse will typically include medication management while helping a person taper off the drug and work through the stabilization phase. Addiction is a chronic and relapsing disease that the National Institute on Drug Abuse (NIDA) compares to other relapsing diseases like hypertension and asthma that have similar relapse rates of around 50 percent. Peer support and 12-step programs are beneficial to minimize episodes of relapse and provide lasting encouragement, and sober interactions.
Suboxone is often used to help preserve abstinence during the maintenance phase of recovery. It may be weaned entirely off during this time or used in conjunction with supportive and therapeutic methods to get to a point where it is no longer needed. Relapse can be minimized, and recovery can be sustained through a comprehensive addiction treatment program that will include aftercare support.